Latex allergy

Essentials

• Suspect latex allergy in a person who gets symptoms from products containing rubber, such as gloves, balloons, babies' dummies, condoms or medical instruments.
• Every patient scheduled to undergo surgery should beforehand be asked about symptoms suggestive of latex allergy.

Aetiology and epidemiology

• Latex allergy is an immediate (type I) hypersensitivity reaction to proteins of the rubber tree. Delayed (type IV) hypersensitivity reaction to chemicals added to natural rubber latex is called rubber chemical allergy. The symptom of delayed allergy is eczema.
• 15 different allergens have been identified in latex.
• About 1% of the population are approximated to suffer from latex allergy, health care personnel more often than general population.
• In the 2000’s, the prevalence of latex allergy has decreased among health care personnel, along with the introduction of powder-free gloves and the reduction of protein content of latex gloves.

Factors triggering an allergic reaction

The following products, for example, may contain latex:
gloves (examination or household gloves, sterile gloves) healthcare equipment, such as catheters, radiographic balloons, manometry balloons, intubation tubes, anaesthesia masks, sphygmomanometer tubingprotective membranes used by dentists (cofferdam)children’s dummies and teats , condoms, rubber bands, balloons.
Surgical, examination or household gloves Sometimes (depending on the material): catheters, radiographic balloons, manometry balloons, intubation tubes, anaesthesia masks, sphygmomanometer tubing Cofferdam of the dentist Babies' dummies made of latex Condoms Rubber bands

Symptoms

• The most severe reactions are usually caused by direct contact of natural rubber latex with mucous membranes during an operation, delivery and different investigations.
• Local or generalized urticaria, swelling and itching
• Hand eczema
• Conjunctivitis
• Rhinitis
• Asthma
• Anaphylactic reaction
• Symptoms vary from mild allergic symptoms to severe anaphylaxis.

Risk groups

Persons who are atopic or suffer from hand eczema
• Repeatedly (especially as a child) operated patients (e.g. spina bifida patients)
• Health care personnel
• Persons using household gloves Young children suffering from food allergies

Cross-reactions

Some allergens in latex have cross-reactions with pollens, such as with birch pollen.
• Allergens of latex cross-react also with some fruits and vegetables (e.g. banana, avocado, chestnut, kiwi)
• The established cross allergies vary based upon the latex allergen the patient is sensitized to.
• The clinical significance and need for an elimination diet depend on the patient’s symptoms. Only food substances that bring about symptoms should be avoided.Cross-reactions to fruit and vegetables (e.g. banana, avocado, kiwi and walnut). In skin tests, mild cross-reactions to latex have also been found in patients who react to birch, fruits or root crops. Inquire about possible symptoms from patients. "?>

Diagnosis

• Essentially based on history of immediate symptoms associated with latex exposure. A positive allergy test result to latex may also be due to cross-reaction and hence does not necessarily mean real latex allergy.
• If real latex allergy is suspected based on the patient’s symptoms, consider referring the patient to a specialist for more thorough investigations.
Sensitization may be examined by skin prick tests and by determining specific IgE antibodies against latex .
• As further allergy workup it is possible to determine IgE antibodies against different proteins in latex.Antibodies to latex may be determined.It is reasonable to determine antibodies to specific allergens when a specific allergy is suspected.
• Challenge tests (skin, lung) are performed at a specialist clinic.

Treatment and prophylaxis

It is essential to avoid contact with products containing natural rubber latex.
• Persons who have had a severe allergic reaction should have an adrenaline auto-injector .
• Staff members with latex allergy can use low allergenic latex gloves if these do not cause any symptoms. If needed, gloves with no latex should be used. All staff members working in the same area should use low allergenic gloves because natural rubber allergens spread into the air by contaminated glove powder. Allergic staff members can use low allergenic surgical and examination gloves if they do not suffer from any symptoms , otherwise gloves without natural rubber or vinyl gloves should be used.
• All staff members working in the same area should use low allergenic gloves because natural rubber allergens spread into the environment by glove powder. Allergic staff members can use low allergenic surgical and examination gloves if they do not suffer from any symptoms , otherwise gloves without natural rubber or vinyl gloves should be used. Health care personnel must use gloves without natural rubber latex when they treat patients with latex allergy. Check the local glove suppliers for non-latex glove alternatives.
• When handling patients with latex allergy it is essential to use gloves and other equipment completely free of natural rubber latex.

Related resources

• Literature

Ədəbiyyat

1. Mari A, Scala E, D'Ambrosio C et al. Latex allergy within a cohort of not-at-risk subjects with respiratory symptoms: prevalence of latex sensitization and assessment of diagnostic tools. Int Arch Allergy Immunol 2007;143(2):135-43.
2. Allmers H, Schmengler J, John SM. Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol 2004;114(2):347-51.